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Ph Ger Alz & Osteo
Pharm Geriatrics
| Question | Answer |
|---|---|
| Chol inhib dosing/timing | Tacrine btw meals, Exelon with meals; Tacrine 4/d; donepezil 1/day, rivastigmine 2/d |
| Only chol inhib avail generically: | Galantamine |
| Chol inhib also w/indication for PD: | Rivastigmine |
| only chol inhib with indication for whole AD spectrum (Mild-Severe) | Aricept |
| donepezil AE | insomnia, GI |
| Exelon AE | worst for GI (Tacrine bad for GI also) |
| Chol inhib DI | Anticholinergics, beta, theophylline (level increased by tacrine) |
| NMDA monitoring | Requires renal dose adjustment; CrCl <30: max dose 5 mg BID |
| Blocks excitatory effect of glutamate: | NMDA antagonist |
| Alz: behavior disturbance: tx | Cognitive Enhancers; Antidepressants; Antipsychotics; Others (Anticonvulsants, Benzo, Trazodone, Buspar, Propranolol) |
| Antipsychotics AE: sedation seen most with: | quetiapine |
| Antipsychotics: AE | 1G & risperidone (2G): EPS, tardive dyskinesia; ortho hypo, long QT, metab; Black box: CV, infxn |
| Meds assoc with delirium | ACUTECHANGEINMS |
| ACUTECHANGEINMS: | Anti-PD, C’steroid, Urologic (antispasmodics), Theophylline, (anti)Emetics, CV (antiarrythmics), H2 blockers (cimetidine), Anticholinergics, NSAID, geropsychotropic, EtOH, insomnia, narcotics, Mx relaxants, Seizure meds |
| Cognitive impairment: Meds are responsible for: | 22-39% of delirium |
| More fractures occur in pts with: | low bone mass (osteopenia) > osteoporosis |
| Bone density screening | DEXA: W >65 & M >70; younger with RF (Low body wt, Prior fx, High risk med); h/o fx > 50 yo; RA and/or glucocorticoid use |
| Who gets osteoporosis tx | Dx osteoporosis on BMD; hip/vert fx; Low bone mass (with other fx; with high-risk condition/med; FRAX 10-yr risk) |
| Bisphosphonates MOA | inhibits bone resorption; act on osteoclasts; decreases rate of bone resorption => indirect increase in bone mineral density |
| Bisphosphonates CI | Hypersensitivity; Hypocalcemia; Esophageal stricture; Inability to sit or stand upright for 30 minutes |
| Bisphosphonates dosing instructions | empty stomach; >8 oz plain water, lots of water (no other liquid); 30-60 min before eat/drink; upright 30-60 min; check CrCl before IV |
| Bisphosphonates AE | Hypocalcemia; Dysphagia; esoph inflame; Gastric ulcer; Visual disturbances; Osteonecrosis of the jaw; acute IV phase rxn (give Tylenol first) |
| Calcitonin MOA | antagonizes parathyroid hormone, inhibits osteoclast bone resorption; nasal spray |
| Calcitonin AE | rhinitis, epistaxis |
| Raloxifene MOA | Selective estrogen receptor modulator; acts like estrogen to prevent bone resorption |
| Raloxifene AE | DVT (CI if h/o VTE); Hot flashes; Edema; Arthralgia; Flu syndrome |
| Forteo MOA | Anabolic, bone-building agent; Recombinant PTH, stimulates osteoblasts, increases calcium absorption and reabsorption |
| Tacrine: monitor: | LFTs q3 mos (hepato tox risk) |
| Antichol inhib: CI | hypersensitivity; jaundice (Tacrine) |
| Chol inhib: formulations | Tacrine: caps; Exelon: has patch; Galantamine has soln |
| NMDA (memantine) dosing | twice daily; titrate dose up each week; indication for mod-severe AD |
| NMDA AE | dizziness, confusion, HA, constipation, cough, HTN; no DI's |
| NMDA: best effect | in combo w/Aricept (but decline still happens over time) |
| AD behavior disturbances: don't respond to meds | wandering; socially inappropriate behavior |
| AD: antipsychotics: sig improvement seen with: | Haldol |
| Drug induced cog impairment: Mgmt | Use least number of meds at lowest dose possible |
| Meds assoc w/bone loss | Glucocorticoids; anticoag; anticonvulsants |
| Daily Vit D req | 800-1000 IU D3 |
| Alz med tx goals | slow cognitive decline progression; preserve functional ability; diminish behav sx; educate pt & caregiver; improve QOL |
| zolendronic acid admin | IV infusion over 15 min; once yearly |
Created by:
Abarnard
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